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At least 667 records · Page 37Linked to original sources
PubMed1989

Internal fixation of femoral capital physeal injuries in dogs: 40 cases (1979-1987).

Fractures of the femoral capital physis were stabilized with small pins or a lag screw in 36 dogs (4 bilateral injuries). Radiography was used to monitor the development of osteoarthritis in affected joints and narrowing of the femoral neck. More radiographic signs of arthritis (P less than 0.05) developed in the coxofemoral joints of dogs that were less than or equal to 4 months old when injured, compared with those in dogs greater than 4 months old. Of 40 capital physeal injuries, 35% had concurrent ipsilateral coxofemoral joint injuries and developed more radiographic signs of arthritis (P less than 0.05) than did those that had no other coxofemoral injury. Narrowing of the femoral neck developed in 70% of the healing capital physeal repairs, but in most dogs, narrowing was not associated with segmental collapse of the femoral neck. Neither time interval from injury to surgical fixation nor surgical approach used had an effect (P greater than 0.05) on the development of narrowing of the femoral neck.

Age Factors↗
PubMed1989

The neck shaft-plate shaft angle in slipped capital femoral epiphysis.

We looked for structural differences between normal patients and those with slipped capital femoral epiphysis to explain shear failure of the growth plate in terms of mechanics. Hip radiographs of 50 normal adolescents were examined, and it was found that lines drawn along the axis of the femoral neck and perpendicular to the growth plate intersected at an average angle of 23 degrees (neck shaft-plate shaft angle). Radiographs of 50 patients with slipped capital femoral epiphysis were examined, and the femoral neck shaft-plate shaft angle was found to be between 10 degrees and 20 degrees in patients with unilateral slips and less than 10 degrees in patients with bilateral slips. These abnormalities in the femoral neck shaft-plate shaft angle suggest there are mechanical differences between normal hips and those that develop a slip of the capital femoral epiphysis that may predispose to shear failure of the growth plate.

Adolescent↗
PubMed1986

Trans-scapho-capitate perilunar dislocation of the carpus.

Trans-scapho-capitate perilunar dislocation of the carpus is a rare variety of perilunar dislocation. The characteristic feature of this lesion is that the head of the capitate is rotated 180 degrees. The capitate fracture occurs at the neck level and when the body is displaced dorsally with the perilunar dislocation, the unsupported head cannot remain in anatomical relationship with the lunate and thus rotates on itself. The authors report a case that was treated by conservative reduction, the result of which was far from satisfactory. They therefore advise that this lesion should be treated by immediate open reduction with osteosynthesis of the scaphoid.

Adult↗
PubMed1987

Remodelling in slipped capital femoral epiphysis.

In-situ pinning of a slipped capital femoral epiphysis is the most common form of treatment for this problem. To find out if remodelling of the upper femur after pinning occurs often enough to justify this form of treatment and whether secondary osteotomies are required for residual deformity, 82 patients with slipped capital femoral epiphyses were reviewed. X-ray films were studied sequentially, noting remodelling changes in the femoral head and neck. Sixty-eight percent of moderate to severe slips that could be properly assessed showed signs of remodelling. The authors recognized two distinct remodelling processes--one, occurring early, affected the neck adjacent to the growth plate, the second appeared later, more distally along the femoral neck. Very few osteotomies were done for residual deformity. Pinning in situ of a slipped capital femoral epiphysis represents a simple, rapid and effective method of treatment, allowing remodelling even in more severe slips.

Bone Nails↗
PubMed1981

[Experimental studies on the reparative processes of infarcted capital femoral epiphysis in puppies--with special reference to the correlation of radionuclide (99mTc-MDP) uptake with radiological and pathohistological changes (author's transl)].

To investigate the correlation of radiological and pathohistological changes with radionuclide (99mTc-methylene diphosphonate) uptake, avascular necrosis of the femoral capital epiphysis of puppies was produced after the modified method of Henard and Calandruccio, by casting the hip joint in the position of hyperextention, full internal rotation and abduction for eighteen to twenty hours. Seventy-six puppies were divided into three groups according to frequency and time intervals of casting; in group A the animals were cast once, in group B cast twice with one week interval between the 1st and 2nd casting and in group C cast twice as group B but with four-week interval. Radiological, pathohistological changes and RI uptake in the capital femoral epiphysis were sequentially studied at certain intervals (1, 3, 5, 9, 15 and 20 weeks after the 1st casting). The results were as follows: 1) The radiological and pathohistological changes in the upper parts of the femora were simulated to those of human LCPD. At three to five weeks after the 1st casting (in group B and C, after the 2nd casting) radionuclide (99mTc-MDP) accumulation in the capital femoral epiphysis decreased compared with the healthy side. At this point X-ray showed coxa plana or vara and sclerotic changes in ossific nucleus, and "head within a head" feature was recognized in several cases. Pathohistologically, osseous healing and connective tissue invasion into the marrow spaces were recognized surrounding the central necrotized focus with multifarious features. 2) Radiologically in the cases of groups B and C, more severe deformities of the femoral head such as coxa vara and/or coxa plana were noted than in group A. 3) As to the RI accumulation, for 3 to 5 weeks after the last casting RI uptake was shown to decrease and then gradually increase compared with the healthy side, and this tendency was more conspicuous in group C than in groups A and B. It can be concluded that 99mTc-MDP is accumulated greatly at the site of active osteogenesis.

Animals↗
PubMed1984

Capital femoral epiphyseal infarction in skeletally immature broilers.

Varying degrees of capital femoral epiphyseal infarction have been identified in broiler chickens. The extent of vascular occlusion was more extensive than observed in capital femoral dyschondroplasia and growth plate cartilage retention was not a constant finding. Epiphyseal vascular occlusion resulted in growth plate cartilage necrosis. It is suggested that proliferating chondrocyte death and matrix disruption would predispose to epiphyseolysis. Similarities between avian capital femoral epiphyseal infarction and Legg-Calve-Perthes disease have been noted.

Aging↗
PubMed1984

Vibration disease of the capitate.

There are four previous cases of isolated avascular necrosis of the capitate in the literature. This report describes a fifth, and the first to be associated with vibration. A paint sprayer presented with wrist pain, tenderness over the capitate and radiological changes of avascular necrosis of the capitate. Following mid-carpal arthrodesis, he returned to work. The role of trauma and a pre-existing ligamentous abnormality of the wrist in the aetiology of this condition is discussed.

Adult↗
PubMed1981

Dental school capitation - an historical perspective.

The Health Professions Capitation Grant program was in existence for nine years. At its inception the capitation grant program was intended principally to be an incentive program for various health professions schools, dental schools among them, to increase the output of manpower. In recent years, the program had changed its emphasis for dental schools to curricular modifications designed to improve the geographic and specialty distribution of dental graduates. All the same time the appropriations for the program had steadily declined since 1972. These developments and the legislative actions that led to the termination of the capitation program are reviewed.

Government↗
PubMed1978

Valgus slip of the capital femoral epiphysis.

Valgus slip of the capital femoral epiphysis, a rare entity which may be acute or chronic, occurred in a 12-year-old boy. The displacement may be associated with a pre-existing coxa valga. The patient also had a varus slip of the capital femoral epiphysis on the contralateral side. Both hips were successful treated by in situ pinning. A review of the English literature reveals only 8 previously reported cases of valgus slipping of the capital femoral epiphysis. Either valgus or lateral slips are unusual.

Child↗
PubMed1982

The John Charnley Award Paper. Experimental epiphysiolysis: etiologic models slipped capital femoral epiphysis.

The several anatomic features that permit the growth plate to resist shear forces were identified. Specific variations in these anatomic features were correlated with pathologic factors known to be associated with epiphysiolysis, including clinical correlations with slipped capital femoral epiphysis. Two models of epiphysiolysis representing different pathogenetic pathways were established in the pig and compared to clinical slipped capital femoral epiphysis in the human. Both experimental models and other models reported in the literature bear similarities mechanically and histologically to the human disease. Available evidence suggests that slipped capital femoral epiphysis may not be a single disease but a final mechanical event that occurs as a result of a variety of disease processes. These disease processes reduce by different mechanisms the ability of the growth plate to resist shear forces.

Adolescent↗
PubMed1981

A histochemical study of slipped capital femoral epiphysis.

UNLABELLED: Core biopsies of the proximal femoral growth plate from three patients with slipped capital femoral epiphysis were compared with three normal growth plates from patients of similar ages. The growth plates of patients with slipped capital femoral epiphysis had a normal resting zone, a loose and fibrillated proliferative zone, and a very disarranged and thickened hypertrophic zone. The proliferative zone stained strongly with alcian blue, suggesting the presence of abundant proteoglycans in the cartilage matrix. The thickened hypertrophic zone was strongly positive to periodic acid-Schiff stain, indicating the presence of abundant structural glycoproteins. Enchondral ossification was scanty and irregular, and there were large clusters of cartilage in the metaphysis. Slippage occurred through the thickened proliferative and hypertrophic zones. CLINICAL RELEVANCE: The proximal femoral growth plate in slipped capital femoral epiphysis is histochemically abnormal and histologically disarranged. These features contribute to abnormal widening of the growth plate and to further slippage.

Adolescent↗
PubMed1995

Scapho-capitate syndrome: distant fragment migration.

The authors wish to report a case of scapho-capitate syndrome with distant migration of the head of the capitate, an injury previously undescribed in English literature. The head of the capitate in this case, was found to lie just proximal to the transverse carpal ligament, deep to the median nerve which was tented over it. It was retrieved and replaced in its anatomical location. Following fixation of both fractures, satisfactory stability was restored in the wrist. The patient was followed for a period of nine months, at the end of which, his wrist was non-tender with a functional range of motion.

Adult↗
PubMed1993

Biomechanical comparison of 1-screw and 2-divergent pin internal fixations for treatment of slipped capital femoral epiphysis, using specimens obtained from immature dogs.

Biomechanical strength and stiffness of 2 fixation treatments used to repair acute slipped capital femoral epiphysis were evaluated in bone specimens form immature dogs. A servohydraulic testing machine was used to create slipped capital femoral epiphysis in 7 pairs of femurs by shearing the capital femoral epiphysis along the physis in a craniocaudal direction. The slip was reduced and repaired with one 3.5-mm-diameter screw placed in lag fashion or 2 double-pointed, 1.6-mm (0.062 inch)-diameter smooth pins and retested. Strength and stiffness of each intact femur (which served as the control) and repaired femur were compared. Results of the study indicated that the failure strength of 2-pin fixation was significantly (P < 0.05) weaker than its control and the 1-screw fixation. There was no significant difference between failure strength of the 1-screw fixation and its control. The stiffness of 1-screw and 2-pin fixations was not significantly different, compared with each other, but was significantly (P < 0.05) less, compared with their respective controls.

Animals↗
PubMed1977

Capitation in dentistry: a quasi-experimental evaluation.

Two matched samples of 245 patients were drawn from solo dental practices which contained both capitation and fee-for-service components. All services rendered to patients during their entire time under care of the practice were recorded and analyzed. Results indicate different styles of care under the two payment mechanisms. An improved preventive style was associated with capitation, as well as fewer fillings. Outcome measured by a modification of the DMF (decayed-missing-filled) Index was also more favorable under capitation.

Adolescent↗
PubMed1996

Screw fixation of Grade III slipped capital femoral epiphysis.

From 1987 to 1992, 161 children were treated at The Children's Hospital of Philadelphia for slipped capital femoral epiphysis. Of these, 23 patients (23 hips) had Grade III slips (> 50%). Fixation was achieved by 1 or 2 screws in all patients. Twenty-one of 23 patients were available for followup (average followup, 2.8 years). Four slips were acute, 11 were acute-on-chronic, and 6 were chronic. At the most recent followup, radiographs were taken and a Harris Hip Score was assigned for each patient. Stabilization without progression of slip at followup was achieved in all patients. Screw placement was satisfactory per the criteria of Stambough in all patients. Four children (19%) had major complications: Three (1 acute slip and 2 acute-on-chronic slips) had avascular necrosis of the femoral head; One (chronic slip) had chondrolysis. There were no immediate postoperative complications. The mean Harris Hip Score for these 4 patients was 85 points, versus a mean score of 94 points for all 21 patients. Chronic Grade III slipped capital femoral epiphysis can be treated safely and effectively by screw fixation. Five of 6 patients had satisfactory results; the only exception had evidence of chondrolysis preoperatively. Acute and acute-on-chronic Grade III slipped capital femoral epiphyses treated with screw fixation are less predictable. In 15 patients, reduction occurred in 9 hips despite deliberate avoidance of forceful manipulative maneuvers. Avascular necrosis developed in 3 (33%) of these 9 hips. Reduction of the acute component of the slip during screw fixation, whether deliberate or not, indicates gross instability. It is hypothesized that avascular necrosis may be associated with injury to the epiphyseal vasculature occurring at the time of the acute slip.

Adolescent↗
PubMed1996

Treatment of the unstable (acute) slipped capital femoral epiphysis.

Slipped capital femoral epiphysis, the most common hip disorder in adolescence, traditionally has been classified according to symptom duration. An acute slip is 1 in which there are symptoms for < 3 weeks; for a chronic slip, there are symptoms for > 3 weeks. An acute-on-chronic slip is characterized by a combination of both with a recent exacerbation of symptoms. This classification system is misleading because it does not consider stability. A stable slipped capital femoral epiphysis has a good prognosis, but an unstable slip has a guarded prognosis. The priorities in treating an unstable (acute) slip are (1) to avoid avascular necrosis, (2) to avoid chondrolysis, (3) to prevent further slip, and (4) to correct deformity. The last priority, correcting the deformity, is associated with a high incidence of complications including avascular necrosis and chondrolysis, so manipulative reduction under anesthesia or an acute corrective osteotomy is not recommended. To address these priorities in treatment, the authors recommend preoperative bed rest to decrease the synovitis and intraarticular effusion. Operative stabilization is done in an elective fashion once the synovitis has subsided. The technique includes careful patient positioning on the fracture table, which may cause an incidental reduction, but no attempt is made to do a manipulative reduction. The technique is dependent on radiographic control. The femoral head and neck must be well visualized on the anteroposterior and lateral intensifier images before the operation is started. The slipped capital femoral epiphysis is stabilized with a single central screw, and nonweightbearing ambulation with crutches is recommended until a satisfactory painless range of motion has returned.

Acute Disease↗
PubMed1997

[Callus distraction for progressive lengthening of the capitate bone after resection of the lunate bone in stage III lunate malacia. Surgical technique and 1 year results].

Inspite of the excellent subjective judgement and functional results of Graner's operation in case of Kienbock's disease stage III, this technique is rarely used nowadays because of its high rate (20 to 30%) of disturbed fracture healing due to impaired blood supply. To avoid the risk of complete devascularization in the capitate region, we are using the callotaxis lengthening technique of Ilizaron, carrying out a segmental shifting. After percutaneous temporary SC- or STT-arthrodesis with the scaphoid in the horizontal or high position, the lunate is completely resected using a dorsal approach. Osteotomy of the capitate is carried out at the corpus-collum interval in order to disturb a minimum of the vascular supply to the bone. Seven to ten days postoperatively, distraction is started with a rate of 1 min/day. The desired distraction length is accomplished, when the capitate articular surface fits perfectly into the curvature of the proximal row articular surface. In order to reduce or prevent soft tissue related complications during the consolidation period, the external distractor is replaced by two percutaneous Kirschner-wires. The consolidation period takes twice as long as the distraction period. Since November 1993, fourteen patients presenting a stage III Kienböck's disease have been treated by this new technique. The operative technique, postoperative care, as well as the potential and real complications are described and illustrated by one clinical case.

Adult↗
PubMed1997

[Pseudarthrosis of the capitate bone. Report of 2 cases].

Well protected by its central position and richly vascularized, the capitate bone is rarely involved in posttraumatic pseudarthrosis. Drawing on two cases, the present study will describe anatomy, aetiology, pathogenesis, diagnosis, and therapy of pseudarthroses of the capitate. Restoration of the physiological capitate height was achieved in both cases with a corticocancellous bone graft from the iliac crest which led on to bony union within three months.

Adult↗